Provider Demographics
NPI:1871979096
Name:KACK, MEGAN (DDS)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:KACK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 N MONROE ST.
Mailing Address - Street 2:
Mailing Address - City:MINNEOTA
Mailing Address - State:MN
Mailing Address - Zip Code:56264
Mailing Address - Country:US
Mailing Address - Phone:651-686-6800
Mailing Address - Fax:651-686-7800
Practice Address - Street 1:530 W PLEASANT ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-0438
Practice Address - Country:US
Practice Address - Phone:507-345-6478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2016-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13539122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist